Cited by 376Chronic Kidney Disease and DiabetesRenal Diseases and GlomerulopathiesAcute Kidney Injury Research

Renal Function in Diabetic Disease Models: The Tubular System in the Pathophysiology of the Diabetic Kidney

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Vallon, Volker, Thomson, Scott C.·2012·Annual Review of Physiology

Abstract

Diabetes mellitus affects the kidney in stages. At the onset of diabetes mellitus, in a subset of diabetic patients the kidneys grow large, and glomerular filtration rate (GFR) becomes supranormal, which are risk factors for developing diabetic nephropathy later in life. This review outlines a pathophysiological concept that focuses on the tubular system to explain these changes. The concept includes the tubular hypothesis of glomerular filtration, which states that early tubular growth and sodium-glucose cotransport enhance proximal tubule reabsorption and make the GFR supranormal through the physiology of tubuloglomerular feedback. The diabetic milieu triggers early tubular cell proliferation, but the induction of TGF-β and cyclin-dependent kinase inhibitors causes a cell cycle arrest and a switch to tubular hypertrophy and a senescence-like phenotype. Although this growth phenotype explains unusual responses like the salt paradox of the early diabetic kidney, the activated molecular pathways may set the stage for tubulointerstitial injury and diabetic nephropathy.

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Crossref · 10.1146/annurev-physiol-020911-153333

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  • SGLT2 inhibitors suppress glomerular hyperfiltration, likely reflecting reduced intraglomerular pressure in response to reduced proximal tubule Na reabsorption.

    “SGLT2 inhibitors (SGLT2i) suppress glomerular hyperfiltration, likely reflecting reduced intraglomerular pressure in response to reduced PT Na ϩ reabsorption (38,39).”
  • TGF provides a partial correction by increasing GFR, but if the pressure-natriuresis mechanism does not sufficiently adjust distal Na+ reabsorption, any remaining Na+ imbalance will cause additional fluid retention, increases in renal perfusion pressure, and increasing glomerular pressure and GFR until Na+ excretion again equals intake.

    “TGF provides a partial correction by increasing GFR (although hyperfiltration will occur even in the absence of TGF) (38), but if the pressure-natriuresis mechanism does not sufficiently adjust distal Na ϩ reabsorption, any remaining Na ϩ imbalance will cause additional fluid retention, increases in renal perfusion pressure, and increasing glomerular pressure and GFR until Na ϩ excretion again equ”

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Authors
Vallon, V., & Thomson, S. C.
Affiliations
  • University of California San Diego (US)
  • VA San Diego Healthcare System (US)
Venue
Annual Review of Physiology
Published
2012-03-17
Volume
74
Issue
1
Pages
351-375
ISSN
  • 0066-4278 (ISSN-L)
  • 1545-1585
OpenAlex
W2112710337
Cited by
376
References
153
Citations by year
2026: 14 · 2025: 21 · 2024: 25 · 2023: 35 · 2022: 40 · 2021: 30 · 2020: 21 · 2019: 25 · 2018: 34 · 2017: 30 · 2016: 22 · 2015: 28 · 2014: 24 · 2013: 19 · 2012: 8
FWCI
2.17
Type
journal article
Language
en
Open access
Locations
  • Annual Review of Physiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (R01HL094728)
  • National Institute of General Medical Sciences (R01GM66232, R01GM066232)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK-56248, R01-DK28602, R01DK028602, P30DK079337, R01DK056248)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords
diabetic nephropathy, tubuloglomerular feedback, glomerular filtration rate, proximal tubular reabsorption, sodium-glucose cotransport, tubular cell proliferation, TGF-beta, cyclin-dependent kinase inhibitors, cell cycle arrest, tubular hypertrophy, senescence, tubulointerstitial injury, diabetic kidney
MeSH terms
Animals, Diabetic Nephropathies, Electrolytes, Glomerular Filtration Rate, Glucose, Humans, Hypertrophy, Kidney Glomerulus, Kidney Tubules, Kidney Tubules, Proximal, Sodium, Sodium Chloride, Disease Progression, Feedback, Physiological, Glucose Transport Proteins, Facilitative, Glucose Transporter Type 2

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